Sistema de Visión Artificial Introducción

7 In practice, it is unlikely that Category A infectious waste will be encountered in the community setting. Category A substances are likely to cause life-threatening disease and, in general, are able to spread easily and therefore pose a risk to the local community and healthcare workers. If it is suspected that a Category A infectious substance has been encountered, the Health Protection Agency and the Department for Transport should be informed for additional advice and

authorisations regarding the movement of the waste.

8 The Carriage Regulations specify that Category A substances should only be packaged in specialist packages and boxes – for further details see

Chapter 7, ‘Transport packaging and operations’

for transport requirements.

Management of Category B infectious

waste in the community

9 See paragraph 42, ‘Transporting offensive or infectious waste from patients’ homes’ for collection arrangement options.

Assessing whether waste poses a risk of infection

10 Healthcare workers working in the community and in the household environment need to assess the waste they are producing for the hazardous properties it may contain, most notably, “infectious”.

11 To accurately assess whether the waste generated is infectious, a risk assessment should be performed. This should be based on the professional

assessment, clinical signs and symptoms, and

any prior knowledge of the patient. The

following initial generic risk assessment is to be used in conjunction with the waste assessment provided in ‘Healthcare waste definitions and classifications’.

12 The usual contaminants associated with typical items of healthcare waste are blood and body fluids incorporating urine, vomit, sputum, faeces, pus and wound exudates. These general categories should be used to subcategorise the waste as either:

• infectious – waste from any known or suspected infection, and from any other cases where a risk of infection has been identified; or

• contaminated with body fluids more suited to the offensive classification (that is, lower risk wastes).

13 The waste, the risk posed by the waste and the waste classification will always be classified the same regardless of the healthcare setting (for example whether in the acute hospital or the community environment).

14 Examples of contaminated items are swabs/wipes, bandages, bed pads, equipment, protective clothing (gloves, aprons), single-use items. Table 15 provides a matrix for classifying offensive and infectious waste in the community. This should be referred to in line with Chapter 4, ‘Healthcare waste

definitions and classifications’.

Note on patients colonised with microorganisms that staff traditionally manage with protective equipment such as gloves and aprons (for example MRSA, glycopeptide-resistant enterococci (GRE) or colonisation with other multi-resistant bacteria)

Where a patient in the community has been found to be carrying a multi-resistant organism and is being cared for by a healthcare worker, the healthcare waste generated is not necessarily infectious.

In assessing the risk of infection from waste produced by such a patient, the following should be considered: Is the patient colonised but not receiving specific treatment for infection with this microorganism (for example MRSA)?

If the answer is “yes”, the status of the patient does not affect the assessment of the waste. The healthcare worker should refer to the wound and dressing assessment given in part 1 and part 2 in this sector guide.

Is the patient colonised and receiving treatment for an infection (for example, MRSA)?

If the answer is “yes”, an assessment of waste is required.

Is the patient infected with MRSA and receiving treatment, and is the microorganism present in the waste generated?

If the answer is “yes”, the waste produced should be classified as infectious waste.

15 Following the generic assessment, there are two further parts to the risk assessment.

Part 1: wound assessment

16 The following criteria are based on the Delphi process of identifying wound infection in six different wound types (European Wound Management Association, 2005).

Signs and symptoms of infection

Probability of wound being infected

Is there presence of erythema/cellulitis?

High

Is there presence of pus/ abscess?

High

Is the wound not healing as it should, or has healing been delayed?

Medium

Is the wound inflamed and has it changed appearance?

Medium

Is the wound producing a pungent smell?

High

Is the wound producing an increased purulent exudate?

Medium

Has the wound increased in pain?

High

Has there been an increase in skin temperature?

Medium/Low

Is the patient on antibiotics for an infection present in the wound?

High

Is the wound to be swabbed for infection?

Medium

Note:

It should be recognised that this is not an exhaustive list of signs and symptoms of wound infection and that different types of wound will present differently. This tool is to assist in the basic assessment of all wounds in order to correctly categorise whether the waste produced contains an infectious fraction and therefore infectious waste. Further information and advice regarding assessment of wound infections should be sought from the local tissue viability specialist nurse. 17 If the wound assessment indicates that the wound

is infected, all associated contaminated dressings etc should be classified as infectious waste to comply with the definitions of infectious waste given in Appendix C9 of WM2.

18 If there are any other reasons why the waste may present a risk of infection, it should be classified as infectious waste and disposed of appropriately. If the waste is infectious, this will need to be packaged for appropriate treatment and disposal. This will usually be in an orange bag.

Table 15 Risk assessment approach to waste segregation based on likelihood of infection being present Contaminant Proposed general

classification

Examples Exception to this rule

Urine, faeces, vomit and sputum

Offensive (where risk assessment had indicated that no infection is present, and no other risk of infection exist)

Urine bags, incontinence pads, single-use bowls, nappies, PPE

Gastrointestinal and other infections that are readily transmissible in the community setting (e.g. verocytotoxin-producing Escherichia

coli (VTEC), campylobacter, salmonella,

chickenpox/shingles)¹

Hepatitis B and C, HIV – only if blood is present¹

Blood, pus and wound exudates

Infectious unless assessment indicates no infection present. If no infection, and no other risk of infection, then offensive

Dressings from wounds, wound drains, delivery packs

Blood transfusion items

Dressings contaminated with blood/wound exudates assessed not to be infectious. Maternity sanitary waste where screening or knowledge has confirmed that no infection is present and no other risk of infection exists

Notes:

All Category A and B species, and therefore downstream waste items, will be deemed infectious/hazardous under waste regulations irrespective of the contaminant matrix.

1 Potential hazards from the use of cytotoxic and cytostatic medicines may also be relevant in some instances and with some drugs. This would also prevent the waste being considered offensive

Part 2: non-infectious dressings

19 Where either assessment above has identified that the dressing is not infectious, the following should be considered (noting that the type of dressings that are produced in the community by a